US News Doctors find air pocket where part of man’s brain should be

08:45 13 march 2018

08:45 13 march 2018 Source:
washingtonpost.com

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It was only after CT and MRI scans that the patient's medical team made an alarming discovery: Where much of the man ' s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

An elderly man who turned up in an emergency department in Northern Ireland after a series of falls has stunned doctors who found a huge air -filled cavity where part of his brain should have been .

The 84-year-old man arrived in the emergency room with complaints that weren't uncommon for a patient his age.

He had reported feeling unsteady over the last several months, culminating in repeated falls in recent weeks. In the three days leading up to his hospital visit, his left arm and leg had noticeably weakened.

Still, there were no red flags in the man's medical history. He didn't smoke. He rarely drank. A blood test detected nothing abnormal.

“There was no confusion, facial weakness, visual or speech disturbance,” doctors stated in a summary of the man's case published Feb. 27 in the medical journal BMJ Case Reports. “He was otherwise fit and well, independent with physical activities of daily living ... and lived at home with his wife and two sons.”

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The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. This article appeared in the South China Morning Post print edition as: Where ’ s his brain ? Scan shows air pocket in skull.

It was only after CT and MRI scans that the patient’s medical team made an alarming discovery: Where much of the man ’ s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

In other words, doctors thought, there was nothing apparent that would have suggested a clear reason for his symptoms. In a way, they wouldn't be wrong.

It was only after CT and MRI scans that the patient's medical team made an alarming discovery: Where much of the man's right frontal lobe of his brain should have been, there was simply a large blank space.

Finlay Brown, a physician who was working in the emergency department at Causeway Hospital in Coleraine, Northern Ireland, at the time, remembers reviewing the brain-imaging scans with the rest of the staff.

"(We) were all very perplexed by the images we saw!” Brown told The Washington Post in an email.

The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. He said he had not.

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Further investigation leads to more surprises, and theories about how the cavity got there and why it grew.

It was only after CT and MRI scans that the patient’s medical team made an alarming discovery: Where much of the man ’ s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

It turned out the man had pneumocephalus, or the presence of air in his cranium, a condition that is found in “nearly 100 percent of cases after brain surgery,” Brown said. It can also occur after sinus infections and head or facial injuries — but with pockets of air or gas that are far smaller.

In this case, the patient's pneumatocele — or pressurized air cavity — measured about 3½ inches at its longest, according to the BMJ Case Reports article.

“In my research for writing the case report I wasn't able to find very many documented cases of a similar nature to this one,” Brown told The Post.

The pneumatocele's likely cause, an MRI would show, was an osteoma, or benign bone tumor, that had formed in the man's sinus and was eroding through the base of the skull, Brown said.

The tumor's formation and location had allowed for something of a “one-way valve effect” that had gradually contributed to the cranial air cavity, he added.

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The 84-year-old man arrived in the emergency room with complaints that weren't uncommon for a patient his age. He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks.

After CT and MRI scans, the medical team made an alarming discovery: Where much of the man ' s right frontal lobe of his brain should have been , there was a Brown said the patient could have undergone surgeries: One that would decompress the air pocket in his head and another that would eliminate

“From speaking to the specialists, it seems it has been progressing insidiously over months to years,” Brown said. “When the patient sniffed/sneezed/coughed he would most likely be pushing small amounts of air into his head.”

The air cavity was also reported as a “rare cause” of a small stroke the man had suffered, which had likely led to the left-side weakness and other symptoms that prompted the man's hospital visit, according to the BMJ Case Reports study.

Brown said the patient could have undergone surgeries: One that would decompress the air pocket in his head and another that would eliminate the tumor that had created the “one-way valve” and allowed air to move into the cavity in the first place.

However, the man declined both, because of his age and other health factors. He was given medication to prevent a secondary stroke and sent home with orders to monitor whether his left-side weakness worsened.

His nonsurgical approach is not without risk: It's likely the patient will be at a greater risk for infection, since there remains a passageway for air — and therefore bacteria and viruses — into his brain cavity, Brown said.

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The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. A scan of the man ' s skull shows the air pocket (the black space) where part of his brain should be .

It was only after CT and MRI scans that the patient's medical team made an alarming discovery: Where much of the man ' s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

“Unfortunately, as there are not many cases published, it is hard to know the exact prognosis,” Brown said.

So far, though, the man appears to be doing well, despite the cranial air pocket. During a follow-up appointment 12 weeks after his hospital visit, the patient reportedly no longer felt weakness on his left side and “remained well,” according to his case study.

Brown told LiveScience he wanted to publish this case study to stress “the importance of thorough investigation of even the most common of symptoms,” as an octogenarian's frequent falls and imbalance could have easily been written off.

“Because every now and then, there will be a rare [or] unknown causation of these that could be overlooked,” he told the science news site.

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Doctors find air pocket where part of man ’ s brain should be - www.washingtonpost.com

It was only after CT and MRI scans that the patient's medical team made an alarming discovery: Where much of the man ' s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

Doctors stunned to find huge air pocket where part of man ' s brain - www.theguardian.com

An elderly man who turned up in an emergency department in Northern Ireland after a series of falls has stunned doctors who found a huge air -filled cavity where part of his brain should have been .

Doctors find giant air pocket where part of man ’ s brain should be - www.scmp.com

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Doctors find air pocket where part of man ' s brain should be - www.mercurynews.com

It was only after CT and MRI scans that the patient’s medical team made an alarming discovery: Where much of the man ’ s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

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Further investigation leads to more surprises, and theories about how the cavity got there and why it grew.

Doctors find air pocket where part of man ’ s brain should be - www.tampabay.com

It was only after CT and MRI scans that the patient’s medical team made an alarming discovery: Where much of the man ’ s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

Doctors Find Air Pocket Where Part Of Man ' s Brain Should Be - www.ndtv.com

The 84-year-old man arrived in the emergency room with complaints that weren't uncommon for a patient his age. He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks.

Doctors find air pocket where part of man ' s brain should be - www.nzherald.co.nz

After CT and MRI scans, the medical team made an alarming discovery: Where much of the man ' s right frontal lobe of his brain should have been , there was a Brown said the patient could have undergone surgeries: One that would decompress the air pocket in his head and another that would eliminate

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The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. A scan of the man ' s skull shows the air pocket (the black space) where part of his brain should be .

Doctors find air pocket where part of man ' s brain should - SFGate - www.sfgate.com

It was only after CT and MRI scans that the patient's medical team made an alarming discovery: Where much of the man ' s right frontal lobe of his brain should have been , there was simply a large blank space. So far, though, the man appears to be doing well, despite the cranial air pocket .

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